I’m in my second trimester, and my husband and I are trying to decide whether or not to circumcise our son. What did you do?
Our Mommy MD Guide’s reply: My husband and I did not circumcise our sons. We looked at the medical literature and found thatthe reasons given for having a baby circumcised were not valid. We were also taught in residency that it was unnecessary and probably harmful.
Circumcision came into vogue in the U.S. in the late 1800s as a cure for masturbation, epilepsy, insanity and various other bizarre “diseases”. These “cures” have all been disproven over time. Circumcision rates continue to drop in the U.S. because parents are educating themselves about the harmful effects of infant circumcision through easy access to the Internet and through discussions with other people who are not circumcised.
The foreskin is loaded with fine-touch nerves, which enhance sexual pleasure for males and females, and it has important functions in reproduction and sex. The United States, an ethnically diverse population, includes many people from countries that do not circumcise. They appreciate the value of the intact penis. Many intact males say that the foreskin is more important than the glans, and very few are willing to part with it later in life.
We learned that the foreskin requires no special care other than routine cleaning of the outside penile skin, in the same way girls are bathed. The foreskin is a complex five-layered fold of muscle, skin and nerves, which covers the glans acting as a one-way valve. This prevents anything from getting under the foreskin, but allows urine out. It keeps the glans moist and clean. At birth until usually around three to ten years of age, the foreskin is tightly attached to the glans. It then slowly separates naturally over time allowing the child to retract it as needed during bathing. Many physicians advise parents to forcibly retract the foreskin on babies or toddlers in order to clean under it, but this only leads to unnecessary pain, irritation and trauma. It is best to leave it alone and let the child figure out when it is comfortable to retract.
Circumcision is painful and traumatic. Studies show that infants actually feel more pain than older children or adults, and infants remember that pain. Newborns have been proven to have a greater pain response because the infant spinal nerves are more excitable, natural neurological pain-killing mechanisms are not present, and a baby’s sensory mechanism is more sensitive and susceptible to injury because of a greater concentration of nerve endings in the skin. Newborn circumcision is rarely done with adequate anesthesia as only general anesthesia would provide complete pain relief during surgery. Typically only local, or no, anesthesia is used. These do not provide proper pain relief, and there is no pain medication given after the surgery even though the pain can last for 2-3 weeks. Circumcision on infants was started in the U.S. because few adults consented to the surgery. Babies are easier to strap down and can’t fight or talk back like an adult. Few, if any, adults would choose circumcision under a local anesthetic. It would be quite painful just as it is for babies. (At least adult male foreskins have separated from the glans, unlike an infant’s foreskin which has to be ripped away from the glans.)
Circumcision often disrupts bonding and breast-feeding. It can lead to panic attacks and other psychological problems later in life. A study from Europe noted that American male toddlers had significant differences in behavior compared to European toddlers, which was attributed to circumcision. Boys left intact tend to be calmer and better able to express their feelings, as documented in a recent study.
Infant circumcision is responsible for many complications. In fact, studies show that between 5-15% of boys will end up with significant problems. Complications range from excessive bleeding, infection, irritation and narrowing of the urethral opening to accidental removal of all or part of the penis, and even death. Sexual function is altered. Many circumcised boys will lose the tissue necessary for a full erection; all will lose the protection of the foreskin and lose the most sensitive and functional part of their penises, without their consent.
Circumcision does not prevent urinary tract infections, penile cancer, cervical cancer, sexually-transmitted diseases or HIV. Non-circumcising countries, like Japan and Denmark, actually have lower rates of these diseases. Newborns are not at risk for any of these except a rare urinary or yeast infection. Yeast infections and urinary tract infections are easily treatable with medications, as in females. A recent Australian study showed that adult circumcised males actually have higher rates of sexually-transmitted diseases compared to intact males. HIV transmission, as well as other sexually-transmitted infections, is related to risky sexual behaviors, and the failure to either abstain from sex or use condoms. The African studies purporting to show a decreased incidence of HIV resulting from circumcision actually have major flaws and biases, which negate any benefits shown. It does not make sense to remove healthy tissue at birth in order to possibly prevent some disease in adulthood. We do not remove any other body part for this reason.
If it is not appropriate to hit a child or yell at a child or touch a child’s genitals inappropriately, then why is it appropriate to cut off normal body parts under inadequate anesthesia? Isn’t the child going to remember this at some level in the brain? We are quite sure children at any age do remember physical and emotional and sexual abuse, and it does have an impact. It is no different than taking home an abused dog from the animal shelter: they will have issues related to their abuse. There is evidence that males do indeed remember their circumcisions and that it rewires the brain.
Many parents believe that boys, just like girls, should be entitled to protection of their bodies (physical integrity) and be allowed to make their own decisions (autonomy) about their bodies in situations where the intervention is unnecessary. The Royal Dutch Medical Association recently advised physicians to stop performing circumcisions until the boy can make this decision for himself. They point to the increased incidence of complications and to the human rights issue to dissuade parents and physicians from performing circumcisions. Forcibly holding a person down and cutting their genitals does not respect that person’s humanity. Teaching boys about regular bathing and about safe sexual behaviors is respectful, and will allow our boys to grow up healthy and whole.
Circumcision on infants is the one aspect of my medical training and practice that bothered me so profoundly that I had to step back and ask myself why I was doing this. It was as traumatic to me psychologically as it was physically to the infants. The answer came to me: it was a procedure done to remove normal, healthy tissue on a patient who could not say no. I was not treating or diagnosing or preventing any disease, which is why I attended medical school in the first place. The only thing I was doing was preventing normal sexual function and normal protection of the glans.
I haven’t done a circumcision since 1988, and I definitely did not have ANY of my children circumcised.
—Michelle Storms, MD, a mom of 24- and 20-year-old sons and a 21-year-old daughter, the assistant director of the Marquette Family Medicine Residency Program in Marquette, Michigan. She is also a member of the health professionals board for Intact America, an organization devoted to protecting the genital integrity of children.
Our Mommy MD Guide’s reply: My family is Jewish, so my son was going to be circumcised. Because my husband’s side of the family has an inherited seizure disorder, we decided to have the circumcision in the hospital rather than at a bris, which is a ceremony of circumcision performed on the male child on the eighth day after his birth
My theory about circumcision is that what’s important is that the dad and the baby match. If the dad is circumcised, I think the baby should be, too.
—Ellen Kruger, MD, a mom of two teenagers and an ob/gyn in an academic and clinical practice in New Orleans, LA, with Ochsner Health System, a non-profit, academic, multi-specialty, healthcare delivery system dedicated to patient care, research and education